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Videosurgery
Laparo-endocopic stone surgery: advantages of alternative approach
José Vicente Baldissera Aradas
Cabuenes University Hospital, Urology department, Gijón, Spain
Citation: Aradas J V B Laparo-endocopic stone surgery: advantages of alternative approach. www.ceju.online/journal/10000/laparoscopic-stone-surgery-LSS-urolithiasis-Stone-free-rate-SFR-1441.php
Key Words: urolithiasis • laparoscopic stone surgery (LSS) • Stone free rate (SFR)

Despite the technical development and expanding indications, the new technologies in ESWL, URSC, RIRS and PNL have not been able to complete replace open surgery(OS). In these cases, laparoscopic surgery could be the most suitable option.

Various factors must be considered in order to offer an optimized surgical treatment.

When patient is counseled on the need for multisession surgery, the overall treatment cost and patient's preferences are important factors to decide treatment modality. Urologist should balance the invasiveness of the procedure and patient's morbidity with stone free rate (SFR). The more invasive selected procedure is, the higher one-session, SFR and a greater postoperative morbidity would be expected.

With rapidly increasing application of laparoscopy in the field of urology, acceptance of laparoscopic stone surgery (LSS) as an alternative to OS is growing.

While 2007 EAU urolithiasis guidelines considered LSS as an "option", in the 2009 edition it was "highly recommended" and since 2012 to the nowadays edition, it's "preferred" LSS before proceeding to OS.

To optimize surgical technique and improve SFR, Salvadó et al. recommended routine exploration of renal pelvis and caliceal system with flexible nephroscopy during LSS.

LSS can be used at different levels of the urinary tract, expanding the indications.

Our aim is to report LSS advantages experienced in a 4 cases mini-serie combining laparo-endoscopic approach.

During 2 years, PNL wasn't available at our institution. PNL in referral hospital was offered. LSS performed in our department was also offered as "alternative approach". The lacks of PNL, stone characteristics (size and Hounsfield units) and patients preferences were considered to proceed to LSS.

2 ureterolithotomy, 1 pielolithotomy and 1 pieloplasty are reported. Grasping forceps and nitinol baskets were used to remove ureteral and intrarrenal stones under laparo-endoscopic combined vision.

Pielolithotomy was performed in extra-renal pelvis. Complete "en-block" staghorn removal was achieved.

Laparoscopic techniques were combined with endourology. Through laparoscopic trocars, a flexible ureteroscope and cistoscope were guided into renal pelvis after uretero-pelvic junction (UPJ) was transected, allowing to extract intra-renal stones during UPJ syndrome pyeloplasty.

Clinical cases are described in the video.

After surgery, patients were classified in low and high risk recurrence, also treated and followed by EAU guidelines recommendations.

LSS advantages include:

Simple manipulation, poor bleeding, short operative time and hospital stay.

LSS represented a safe alternative for impacted ureteral lithiasis in which previously endourologic procedure failed.

Multitrack or multisession surgery could be avoided for staghorn extra-renal pielic lithiasis, achieving no harm to the nephron and saving operative time.

Laparo-endoscopic approach could be related with acceptable SFR.

More comparative studies are needed to define the role of LSS in relation to endourologic and open techniques, especially in complex circumstances.

References
  1. Türk C, Petřík A, Sarica K, Seitz C, Skolarikos A, Straub M, Knoll T. EAU Guidelines on Interventional Treatment for Urolithiasis. Eur Urol. 2015 Sep 3.
  2. Borofsky MS1, Lingeman JE1. The role of open and laparoscopic stone surgery in the modern era of endourology. Nat Rev Urol. 2015 Jul;12(7):392-400.
  3. Jung JH1, Cho SY2, Jeong CW1, Jeong H2, Son H2, Woo SH3, Kim DK3, Min SH1, Oh SJ1, Kim HH1, Lee SB2. Laparoscopic stone surgery with the aid of flexible nephroscopy. Korean J Urol. 2014 Jul;55(7):475-81.
  4. Skolarikos A, Papatsoris AG, Albanis S, Assimos D. Laparoscopic urinary stone surgery: an updated evidence-based review. Urol Res. 2010;38:337–344.
  5. Desai RA, Assimos DG. Role of laparoscopic stone surgery. Urology. 2008;71:578–580.
  6. Lee JW, Cho SY, Yeon JS, Jeong MY, Son H, Jeong H, Kim HH, Lee SB. Laparoscopic pyelolithotomy: comparison of surgical outcomes in relation to stone distribution within the kidney. J Endourol. 2013 May;27(5):592-7.
  7. Nambirajan T, Jeschke S, Albqami N, Abukora F, Leeb K, Janetschek G. Role of laparoscopy in management of renal stones: single-center experience and review of literature. J Endourol. 2005 Apr;19(3):353-9.
  8. Salvadó J.A., Guzmán S., Trucco C.A., Parra C.A. Laparoscopic pyelolithotomy: optimizing surgical technique. J Endourol. 2009;23:575–578.
ACKNOWLEDGMENTS:  to Francisco Javier Cuervo Calvo.
Article history
Submitted: 4 July, 2017
Accepted: 27 September, 2017
Published online: 27 September, 2017
doi: 10.5173/ceju.2017.1441
Corresponding author
José Vicente Baldissera Aradas
email: baldissera758@gmail.com
Conflicts of interest:  The authors declare no conflicts of interest.
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